S7) Urinary Incontinence Flashcards
What is urinary incontinence?
Urinary incontinence is the unintentional passing of urine due to loss of bladder control
There are different types of urinary incontinence.
Identify them
- Stress Urinary Incontinence
- Urge Urinary incontinence
- Mixed Urinary Incontinence
- Overflow Incontinence
- Over active Bladder
- Functional
What is stress urinary incontinence?
Stress Urinary Incontinence is the involuntary leakage of urine on effort, exertion, sneezing or coughing
What is urge urinary incontinence?
Urge Urinary incontinence is the involuntary leakage of urine accompanied by urgency
What is mixed urinary incontinence?
Mixed Urinary Incontinence is the involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing
What is overflow incontinence?
Overflow incontinence is the involuntary leakage of urine from an overfull bladder, often in the absence of any urge to urinate
Have an understanding of the prevalence of urinary incontinence with age
Describe the incidence of the different types of urinary incontinence
Identify 6 risk factors for urinary incontinence
- Obesity → reduces abdominal pressure
- Age
- Gender (more common in females)
- Smoking → increases straining (effort needed to wee)
- Family history
- Neurological disease/diabetes
- Race
- any neurological or anatomical abnormalities
Identify and describe 4 causes of urinary incontinence in females
- Pregnancy – due to hormonal changes and uterine expansion
- Childbirth – weakens muscles needed for bladder control and damages bladder nerves and supportive tissue
- Hysterectomy – due to possible damage of the supporting pelvic floor
- Menopause – due to loss of oestrogen which causes urethra and bladder to deteriorate
Identify and describe 4 causes of urinary incontinence in males
- Prostate cancer – often incontinence occurs as a side effect of treatments
- Enlarged prostate gland – benign prostatic hyperplasia (more common in older men)
- Prostatectomy – often surgery damages urinary structures
- Prostatitis – prostate swells and compresses urethra
State 4 initial investigations for urinary incontinence
- Urine dipstick (UTI, haematuria, proteinuria, glucosuria)
- Non-invasive urodynamics (frequency-volume chart, bladder diary)
- Invasive urodynamics (pressure-flow studies, pad tests)
- Cystoscopy (camera in bladder)
In the conservative management of urinary incontinence, identify 5 general lifestyle interventions
- Modify fluid intake
- Weight loss
- Stop smoking
- Decrease caffeine intake (UUI)
- Avoid constipation
Identify 3 forms of management for patients with urinary incontinence who are unsuitable for surgery / failed conservative management
- Catheter (suprapubic/urethral)
- Sheath device
- Incontinence Pads
What is the initial management for SUI?
Pelvic floor muscle training – 8 contractions x3/day, at least 3 months duration
What is the pharmacological management for SUI?
Duloxetine – combined noradrenaline and serotonin uptake inhibitor increases activity in the striated sphincter during continence phase
keeps noradrenaline in the bladder for longer and so bladder can be full for longer and the external sphincter can be kept close
Identify 2 types of surgical management for males with SUI?
- Artificial urinary sphincter (external)
- Male sling procedure
Identify 2 types of surgical management for females with SUI
- Low-tension vaginal tapes (permanent)
- Intramuscular bulking agents (temporary) - thickens the wall of the urethra at the bladder outlet so its easier to hold in urine
- vaginal tapes - help keep the bladder and urethra closed
What is the initial management for UUI? (urgency urinary incontinence)
Bladder training – scheduled voiding for at least 6 months duration
Identify and describe 2 types of pharmacological management of urinary incontinence
- β3-adrenoceptor agonist increases bladder’s capacity to store urine
- Anticholinergics act on muscarinic receptors to promote urine retention
Identify 4 types of surgical management for UUI
- Sacral nerve neuromodulation
- Autoaugmentation (change size or shape of the bladder)
- Augmentation cystoplasty
- Urinary diversion
what are two types of natural diuretics
- coffee
- tea
what is an over active bladder
- the need to suddenly urinate frequently that is difficult to control
What are some common symptoms if someone is suffering from a Storage issue
- increased frequency of urination
- urgency
- nocturia
- incontinence
what are some common symptoms if someone is suffering from voiding issues
- slow stream
- splitting or spraying
- intermittency
- hesitancy
- straining
- terminal dribble
what are some common symptoms if someone is suffering from post maturation issues
- dribble
- feeling incomplete of emptying
some signs of a mixed UI
- fluid intake habits (tea/coffee)
- previous pelvic surgery
- history of large babies
- signs of uterovaginal prolapse
what dermatomes should you examine if someone has UI
S2,3,4 keeps the wee and poo off the floor
what are some examinations that you should
- BMI
- abdominal exam to examine the bladder and see if its palpable
- examine S2-4 dermatomes
- digital rectum examination
- females - external genitalia (stress test) and vaginal exam
urodynamics testing
- intravesical pressure → pressure in bladder
- detrusor pressure → stress incontinence
